Primary Care Coding Alert

Online E/M, monitoring codes to change in the New Year.

Beginning on January 1, 2020, you’ll have a whole new way to report asynchronous online evaluation and management (E/M) services. You’ll also have new codes to use when patients monitor their own blood pressure, while the remote physiological monitoring (RPM) codes are getting new time parameters.

Read on and find out if ⎯ and how ⎯ the changes will impact your practice starting in the New Year.

99444 Is No More …

The latest round of CPT^® revisions has eliminated many of the restrictions to virtual E/M services by deleting the existing code and replacing it with a new code and two time-based add-ons.

The deleted code is 99444 (Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network). As its descriptor states, the service as it currently stands must be:

• Provided to an established patient (or guardian).
• Provided by a physician or other qualified health care professional (QHP).
• Unrelated to an E/M service provided within the previous seven days.

Coding caution: These same restrictions remain for the new code, 99421 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes). Most importantly, any online digital E/M service that is the result of a previous, or that results in a subsequent, E/M visit, is not separately reported, and the online digital E/M service is incorporated into the related E/M visit.

In addition, CPT^® has placed a seven-day cumulative time limitation on 99421 and made the code time-dependent. You will be able to use 99421 if your provider spends between five and 10 minutes on the asynchronous communication with the patient in that time; you will also be able to report longer time increments with 99422 (… 11-20 minutes) or 99423 (… 21 or more minutes).

The deletion of 99444, and its replacement with 99421-99423, presents a teachable moment for coders and their providers. “Coders will need to work with their providers to ensure that they are documenting the time factors of the new codes,” advises Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. “The time component was not required for 99444, so this will be an opportunity for education,” Johnson adds.

The good news about the change is that “it compensates the provider for any significant additional time in a seven-day period,” says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania. However, “practices should review their local Medicare Fiscal Intermediaries’ and Medicare Administrative Contractors’ [FIs’/MACs’] policies on these non-face-to-face services,” Falbo cautions.

… While Self-Measured Blood Pressure Monitoring Gets New Codes …

CPT^® 2020 also sees the introduction of two brand new self-measured blood pressure (SMBP) monitoring codes:

• 99473 (Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration)
• 99474 (… separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient).

… and RPM Gets New Times

The last change in the CPT^® E/M codes for 2020 concerns RPM, another form of patient monitoring. In this case, however, the revision is a simple change in the parent code’s time parameters, resulting in the change of the descriptor for 99457:

From: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month
To: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes.

You’ll also be able to report additional 20-minute increments of your provider’s RPM service time with 99458 (… each additional 20 minutes (List separately in addition to code for primary procedure)).

Like the changes to the virtual E/M codes, “this change presents a similar opportunity for coders to educate their providers, as the time components to 99457 and 99458 mean that providers will have to be specific in their documentation compared to the previous requirement of noting ‘more than 20 minutes,’” suggests Johnson.

But “the additional time allowed by this code should not only prove particularly beneficial for patients requiring significant monitoring and interaction during a particular month, but also allow your provider to capture the additional work spent on those patients” Falbo adds.